John Clark MD – Clinical Director, Center for Head and Neck Cancers, Mass General Hospital, Boston – Medical Challenges and Spiritual Considerations in the Treatment of Patients with Cancer

We are in relationships with people – but they are relationships created by illness, by sorrow, by pain. We are bonded by the stories they tell us. We are brought together – could it be by divine intervention?

CAN I BE SPIRITUAL IN MEDICINE?

• “Spiritual” needs may be small/mild/low if the medical need or treatment need is mild, minimal, or acute or reasonably simple. Offer simple reassurance, respect, hope. Live your faith – see the face of Christ in every patient.
• Spiritual needs may be quite high if treatment needs are severe, chronic, or even incurable
• Offer support, respect, hope, insight
• Be patient specific, even offer your own life experiences.
• Build patient trust in the medical system (since that’s where you are meeting them)
• Work within their faith structure – but be aware that it may be different than yours – but it’s ok to ask for respect for your own faith as well. Most will typically accept that.
• It’s a journey not a “process”
• Spiritual needs will often increase as treatment needs decrease as illness progresses – because pt morbidity increases and palliative care increases
• By the time the patient is concerned primarily with end of life issues, they will be nearly 100% concerned with supportive care issues and spiritual care issue, while medical care issues may actually be very minimally an issue for concern.
• Priority is always the patient with the illness NOT the illness itself

When surveyed, patients stated that almost 70% were “highly” religious, and of those, 89% were African American, and 79% were Hispanic; yet 72% the patients surveyed stated that their religious needs were not met at all by the medical team. Yet, studies found that those who utilized some form of religion or spirituality in their life and in their care had a higher quality of life, overall.

Providers must:

• seek opportunities to identify and support spiritual needs
• enhance quality of life, healing, and wholeness
• respect patient boundaries and autonomy
• provider patience and understanding will facilitate proper decision making when time is right
  

Patient’s fear things

• fear is universal
• Hopelessness and depression regarding illnesses, misfortune are common
• If we are not ill, we know someone who is
• We fear loss – loss of independence, work, finances, life
• We fear isolation – from family, friends, community
• We fear dependency – on family, friends, or paid care providers
• We fear that the treatment might not work

We tend not to see that Crisis can be linked to Opportunity

Crisis can often give us a chance to redefine our priorities – but we seldom see this. We are too fearful, anxious, worried about what tomorrow will bring. We set the limits and the boundaries, based on all the fears our imagination can stir up – and we can’t conceive that there might be any blessings inside the clouds we see blocking our way.

We want what we want – and if we can’t have it – it’s a –disaster. Yet – sometimes we are forced to slow down – and in this forced interim, we can redefine our life’s priorities, our marriages priorities, our parenting priorities, sometimes dysfunction from gambling and addiction ends, or we reach out to others from whom we have been estranged. We have a choice. We need to focus – we need to contemplate. Suffering can have meaning.

Spirituality in Medicine

After the rise of Science – via Copernicus and Darwin – spirituality was equated with “superstition” in the minds of many. A view of the universe as created was rejected. The world was “random” and “chaotic” – the scientist who said otherwise was ridiculed - and the training of any sort of spiritual skills in the medical practitioner was left to chance or the choice of the individual practitioner. This despite the research of Gregor Mendal, the Catholic monk who was the pioneer of genetic science, and Georges Lemaitre, Catholic priest and “father” of what came to be called “the Big Bang Theory” of the origins of the universe.

- Francis S. Collins, M.D., Ph.D., is a physician-geneticist and the Director of the National Human Genome Research Institute, NIH – a man who cannot be called anything but a serious scientist – who wrote - "The Language of God: A Scientist Presents Evidence for Belief” in 2006 - and stated - "DNA sequence alone, even if accompanied by a vast trove of data on biological function, will never explain certain special human attributes, such as the knowledge of the Moral Law and the universal search for God." He further insists that "science is not threatened by God; it is enhanced" and "God is most certainly not threatened by science; He made it all possible."

Other respected scientists have written numerous books regarding the junction of science and faith, including:

- Dr. Kenneth Miller - Professor of Biology, Brown University; "Finding Darwin's God: A Scientist's Search for Common Ground Between God and Evolution" - a lively and cutting-edge analysis of the key issues that seem to divide science and religion. He contends that, properly understood, evolution adds depth and meaning not only to a strictly scientific view of the world, but also to a spiritual one. Miller is a firm believer in evolution, he is one of America's foremost experts on the subject, but he also believes in God—and he doesn't think the two beliefs to be mutually exclusive.

- Michael Ruse is a Professor of Philosophy and Director of the Program in the History and Philosophy of Science, Florida State University. He is the founder and editor of the journal Biology and Philosophy, and has appeared on "Quirks and Quarks" and the Discovery Channel - "Darwin and Design - Does Evolution Have a Purpose?" (Toronto Globe and Mail Best Book of the Year) In clear, non-technical language Michael Ruse, a well-known authority on the history and philosophy of Darwinism, offers a full and fair assessment of the status of the argument from design in light of both the advances of modern evolutionary biology and the thinking of today's philosophers--with special attention given to the supporters and critics of "intelligent design."

- Darrel R. Falk is professor of biology at Point Loma Nazarene University in Point Loma, California. He is also the director of the Howard Hughes Medical Institute outreach program. His research interests have included molecular genetics of Drosophila melanogaster, organization of genes; mechanism of repair of chromosome breaks and molecular changes in the Notch gene in various species of Drosophila; and the use of gene cloning technology to characterize damaged chromosomes at the molecular level and PCR and DNA sequencing to compare homologous gene sequences in different species of Drosophila. He has also authored a book on the creation-evolution controversy titled “Coming to Peace with Science: Bridging the Worlds Between Faith and Biology” (2004) – in which he shows how an original and ongoing interaction of God with creation is fully reconcilable with the kinds of development identified by current biological science.

When searching for the answer to the question can I be spiritual in medicine?

• The answer will always be personal
• Spirituality may pre-exist training
• Can develop during clinical practice
• Emphasis in recent training modalities is typically only addressed in addictions programs.
• Any other mention is usually “in passing”
• Most recently (past couple of years since new Joint Commission standards especially)worked directly into medical education – quite often however, medical students may complete a “psych rotation”, with a “spirituality component” and have all the right answers on an exam – but be no better prepared in real, daily practice. They can take spiritual histories - Define spiritual “needs” - but they fall down in actual patient care
• Also recently - Various larger hospitals have formed "Teams" - Could run the risk of forming specific “palliative care teams” where the “job” of spiritual care advisor is farmed out to a consultant or specialist

Spiritual challenges of a patient

• Will it solve everything? NO! It’s a support!!!
• Will it help, or will it hurt? Spirituality is recognized by many studies as beneficial
• A patient asks - "Will my spiritual needs be met even if I have no specific religion?" Yes! Of course!

We wear “multiple hats” every day. Medical/clinical – treatment provider/pharmacist – spiritual counselor/rabbi/priest/deacon/nun – we need to be aware of medical and treatment issues, medication issues, and worship/spiritual issues – we should not become “practicing specialists” – don’t hand off the patient to the specialist, consultant, next treatment team on the list – LISTEN, CARE, DO – and have mercy – open your heart –

We must be like the disciples who went out into the world where they were called, and met the people where they were, and did what needed to be done. St. Paul walked the dusty roads, teaching Timothy and John Mark, patching tents for a living, and sharing the Good News. He converted his jailors from prison, and rejoiced a the thorn in his own side, joining his own suffering with that of Christ crucified. He was “all things to all men” – we must also do this.

Wear as many “hats” as you can….